Abstract WP64: Ultra-early Treatment With IV tPA for Large Artery Occlusion Improves Recanalization Rates and Clinical Outcomes

• Published in: Stroke (1970) Vol. 49; no. Suppl_1
• Main Authors: Di Lorenzo, Rodica, Sheikhi, Lila, Patel, Payal, Donohue, Megan, Wisco, Dolora, Uchino, Ken, Hussain, Shazam M
• Format: Journal Article
• Language: English
• Published: 22.01.2018
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.49.suppl_1.WP64

Abstract only Introduction: Emergent large vessel occlusions (ELVO) cause approximately 45% of ischemic strokes and are associated with poor outcomes. With the advent of intra-arterial therapy (IAT), the role of IV tPA for treatment of ELVO stroke has been questioned. We hypothesized that ultra-early treatment with IV tPA for ELVO stroke improves recanalization rates and clinical outcomes. Methods: Retrospective chart review was performed of patients who received IV tPA for ELVO stroke and were treated at our institution between January 2013 and December 2016. We compared patients treated with IV tPA within 60 minutes of being last known well (LKW) with patients treated beyond 60 minutes in regards to (1) recanalization, defined as complete reconstitution of blood flow on arterial imaging, (2) early neurological improvement, defined as National Institute of Health Stroke Scale (NIHSS) of ≤ 1 or decline by ≥ 5 points at 24 hour post-IV tPA, (3) 90 day functional status measured by modified Rankin Scale (mRS), and (4) mortality at 90 days. Results: Of 201 patients with ELVO ischemic stroke, 158 patients had adequate post-IV tPA arterial imaging. 25 patients were treated within 60 minutes of LKW, while the remaining 133 patients were treated beyond 60 minutes. Groups did not differ in regards to age, gender, cardiovascular risk factors, NIHSS on presentation, baseline mRS, or occlusion location. The percentage of patients who underwent IAT for persistent occlusion did not differ between the two groups. Recanalization of arterial occlusion following IV tPA without IAT, early neurological improvement, survival, and good clinical outcome were more frequent in patients who received IV tPA within 60 minutes of LKW. Conclusion: Our data suggest that ultra-early IV tPA administration for ELVO stroke increases the chance of recanalization and leads to improved clinical outcomes. Prospective studies are needed to verify our findings.